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versión On-line ISSN 2078-5135versión impresa ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.98 no.11 Cape Town nov. 2008

Editor's Choice

Cover pictures - readers invited

For some years the SAMJ cover has featured aspects of South Africa's wonderful natural heritage such as the trees of the lowveld, fynbos flowers and proteas from the Western Cape. This month's cover picture is of Intaka ('bird' in Xhosa) Island.

Intaka is a unique 16 ha wetland and bird sanctuary in the middle of the Century City development some 7 km from Cape Town's CBD. When the developers were planning Century City, nature lovers engaged in a vigorous public debate, including letters in the newspapers, to object to the loss of heron and other nesting grounds in the wetlands.

The outcome was a unique project that has resulted in the upgrading of wetlands that had become badly degraded and are now a remarkable breeding ground and home for about 120 bird species and 177 species of indigenous plants. Intaka Island has paths, hides and resting places for visitors who can enjoy its quiet beauty. Guides are available for tours. Further information can be found on the website www.intaka.co.za

In keeping with our SAMJ theme, readers are invited to submit high-quality photographs of the natural wonders of South Africa for possible display on the cover. We will accept colour prints, but would prefer high-resolution jpegs to be submitted via publishing@hmpg.co.za (for the latter please send only one picture at a time as downloading could be a problem with high-res pictures).

Health Department upgrade

The precipitate departure of Thabo Mbeki from the president's office has had immediate and profound effects for the National Department of Health, and it is to be hoped for the health of the people of our country. The court judgment that provided the impetus for Mbeki's opposition in the ANC to oust him included a damning account of interference in the affairs of institutions, for a fair share of which the Health Department was responsible. Professor Peter Folb, who was chairman of the Medicines Control Council, was fired for refusing to register Virodene, a toxic solvent peddled as a treatment for HIV that had been presented to the cabinet, no less. More recently the instruments of democracy in the health field, the Health Councils (e.g. HPCSA, Nursing), the Medicines Control Council and the Medical Research Council, have been eviscerated of independent minds and packed with political patronage. AIDS denialism and support of AIDS dissents have done serious damage to the health of the people, the morale of health professionals and the reputation of the country. Public health services and facilities have failed dismally due to poor leadership and mismanagement.

The Editor, Professor Dan Ncayiyana, recounts some of the shame that the country endured during this period,1 and Chris Bateman, SAMJ news editor, reports on the hope that health professionals have expressed with the appointment of the new Minister of Health and her deputy.2

Fetal alcohol syndrome

The fetal alcohol syndrome (FAS) has huge social and economic implications for South African society. FAS is caused by prenatal exposure to alcohol and includes some or all of the following features: facial dysmorphism, prenatal and/or postnatal growth retardation, and neurological, cognitive and behavioural abnormalities. The dop system (alcohol forming part of labourers' wages on wine farms) is believed to have played a role in entrenching binge-drinking. Urban and colleagues3 investigated the prevalence of FAS among schoolgoing children in the Northern Cape province, South Africa.

Their study found an extremely high prevalence of FAS (nearly 1 in 10) - higher than previously reported in the Western Cape province. Rates of FAS reported from South Africa are generally much higher than in other countries, where rates of FAS seldom exceed 10/1 000, even in high-risk populations. Noteworthy are the findings that the FAS rate is higher in De Aar (a sheep-farming area) than Upington (a wine-farming area) and that FAS was not limited to a specific ethnic group.

Children with FAS or partial FAS performed poorly across a broad range of neurodevelopmental domains, including markedly lower intellectual functioning and attention deficits.

AIDs is a painful disease

The human immunodeficiency virus (HIV) has a predilection for nerve tissue, so the peripheral nerves, spinal cord and brain are frequently affected in patients with HIV/AIDS. Hitchcock, Meyer and Gwyther4 investigated the prevalence, severity and morbidity of neuropathic pain in AIDS patients before the initiation of antiretroviral therapy.

The most frequent cause of neuropathic pain in patients with HIV infection is a distal sensory neuropathy which may be the result of the HIV infection itself or of neurotoxicity from drugs used in treating patients with AIDS. Of their patients 20.9% had pain of predominantly neuropathic origin and the severity of the pain frequently interfered with all domains of living. The correlation between lower CD4+ counts and higher prevalence of polyneuropathy implies that timely use of antiretroviral therapy could lower the incidence of neuropathic pain.